- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,495.41 / $14,125.38
| Facility | | $1,230.27 | $5,495.41 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $851.14 / $1,862.09
| Professional | | $741.31 | $851.14 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $11,748.98 / $28,183.83
| Facility | | $3,890.45 | $11,748.98 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,047.13 / $2,041.74
| Professional | | $707.95 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,511.89 / $8,912.51
| Facility | | $1,071.52 | $2,511.89 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,202.26 / $2,570.40
| Professional | | $794.33 | $1,202.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,762.47 / $19,498.45
| Facility | | $2,454.71 | $7,762.47 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $1,778.28
| Professional | | $676.08 | $954.99 | $1,778.28 |